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The upper orifice of the Bladder (Pang Guang, 膀胱) is not explicitly mentioned as existing or non-existing in the *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions), leading to endless debates in later generations. Some argue that there is an upper orifice but no lower orifice; this is a misunderstanding of the phrase "when Qi transforms, it can exit." If there were no lower orifice, how could the Qi transform and discharge so smoothly? Therefore, the theory that there is no lower orifice need not be discussed.

Others argue that there is a lower orifice but no upper orifice, a view supported by Zhang Jingyue and Li Shicai. Because the works of Jingyue and Shicai became popular throughout the country in recent times, people generally believed that the Bladder has no upper orifice. However, if there were no upper orifice, in cases of *Jiao Chang* disease (Intestinal-Bladder Fistula/Displacement), from where would feces enter the Bladder? Zhang Sanxi considered the view that both upper and lower orifices exist to be correct, but his explanation was not detailed.

Since water pathways enter the Bladder via the lower orifice of the Small Intestine, why is it that when clear and turbid substances are not separated, it commonly accompanies watery diarrhea from the Large Intestine, whereas *Jiao Chang* disease, where feces enter the Bladder, is rare? Upon careful consideration, the reason must be that the Bladder possesses an upper orifice which is normally closed; this is the normal state of a healthy person. Water entering the Bladder is transformed and entered through the Qi transformation of the Triple Burner (San Jiao, 三焦), not through the upper orifice.

If the Qi of the Fu organs is severely deficient, lacking strength to keep the orifice closed, or if pathogenic heat damages the Fu organ, causing the orifice to open due to the dispersing nature of heat, then feces may enter the upper orifice of the Bladder from the lower orifice of the Small Intestine and be discharged along with urine. This is analogous to the external orifices of the human body, which also remain normally closed and unpatent. For instance, the umbilicus, ears, and breasts are usually closed unless pathology exists, at which point pus/blood or milk may be secreted. The upper orifice of the Bladder can be inferred similarly.

People generally believe there is no upper orifice for two reasons: first, they revere the works of Jingyue and Shicai; second, they observe that animal bladders only have a lower orifice. They fail to consider that living beings created by Heaven and Earth vary greatly. For example, hairy animals possess all five Zang organs, while feathered animals lack lungs and anterior yin openings. Even among humans, differences exist: men have twenty-four ribs, while women have twenty-eight; men have eight cranial bones, while women have six. Since differences exist between individuals, how much more so between humans and animals?